Acute transverse myelitis and associate vaccine complication in SARS-CoV-2 patients: a retrospective cohort analysis in real-world database

Abstract

Introduction: Acute transverse myelitis (ATM) is a rare neurological disorder often associated with infections, autoimmunity, and vaccination. During the COVID-19 pandemic, the incidence of ATM appeared to increase; however, the causal relationship remains uncertain due to limited follow-up and variability in case reporting. This study aims to evaluate the incidence of ATM in SARS-CoV-2 patients, identify associated risk factors, and explore potential links to vaccination using real-world data. Methods: A retrospective cohort analysis was conducted using electronic health records from the USA collaborative network within the TriNetX database. The study included SARS-CoV-2-infected patients and a matched non-COVID-19 cohort from 2020 to 2023. Propensity score matching (1:1) was applied to minimize baseline differences between the groups. Kaplan-Meier survival curves and Cox proportional hazards models were used to assess the risk of developing ATM within a one-year follow-up period. Results: Patients with SARS-CoV-2 infection had a significantly higher risk of developing ATM compared to non-infected individuals (HR = 1.46, 95% CI = 1.21–1.74). Stratified analyses confirmed this increased risk across various subgroups, including patients younger and older than 65 years, both males and females, and those infected during the Alpha strain-dominant period. No statistical significance between patients with and without SARS-CoV-2 infection after received different SARS-CoV-2 Vaccines. Conclusion: SARS-CoV-2 infection appears to be more strongly associated with ATM than COVID-19 vaccination. Given the potential for lifelong disability and the need for long-term care in affected individuals, further studies are warranted to explore the underlying mechanisms and preventive strategies.